President Emmanuel Macron: En marche for a public health revolution?

It’s official: the French have voted in a pro-European president, marking a turning point in French and European politics. A strong believer that France’s long-term sovereignty lies in the EU, Emmanuel Macron plans to focus on incentives for further European integration in many fields. But what about health?

Cambre

His programme offers a lucid assessment of the current state of the French healthcare system, with prevention, better access to healthcare, and innovation at its core. But can it withstand the test of reality, and even inspire the EU and other Member States to follow suit? Together with French partner agency Maarc, Cambre sheds light on President Macron’s proposals.

Prevention

Emmanuel Macron is not one to shy away from big words. Characteristically, his programme calls for nothing less than a ‘révolution de la prévention’, in which he envisions a healthcare system that empowers patients and prevents citizens from getting sick. At the heart of this revolution, Macron proposes a so-called ‘service sanitaire’ that will engage up to 40.000 medical students in strengthening health prevention and literacy programmes in schools and work places. The new President also puts forward prevention programmes to address major health risk factors such as the consumption of tobacco and alcohol, obesity and physical inactivity.

His plans against tobacco are ambitious, aiming to make today’s newborns the first non-smoking generation in French history. Beyond basic healthcare education, Macron wants to increase the price for a package of cigarettes to €10 (which would be one of the highest unit prices in Europe, just after the UK and Norway). He also calls for a stronger coordination of tobacco policies among EU Member States.

His alcohol policy proposals however are less revolutionary. Macron rejects additional taxation of alcoholic beverages and defends the existing ‘Loi Evin’, which aims to protect children and young people from exposure to influential lifestyle-based alcohol marketing messages. Further, his programme remains vague regarding the evolution of alcohol labelling. Any far-reaching initiatives in this field are thus unlikely.

In the fight against obesity Macron takes a similar stance. On the one hand, he is in favour of the Nutriscore food labelling system, which is part of current traffic-light labelling system trials in France. Following comparable attempts in the UK, the trial and Nutriscore approach may lead other Member States to adopt similar strategies. On the other hand, Macron rejects the introduction of any taxation methods based on the composition of food.

Finally Macron intends to support environmental health research and reduce the risk of exposure to risky substances such as endocrine disruptors, without further explaining how at this stage.

Macron’s proposals are therefore not truly revolutionary, but largely follow policies of the previous Presidency. However, it will be interesting to see whether initiatives in the field of food labelling and tobacco policies will have an impact at EU-level.

Equal and better access to healthcare

Improving equal access to healthcare is the other public health challenge of Macron’s upcoming Presidency. His programme focuses on the evaluation of public health services and medicines, as well as ambitious reform and investment plans.

Macron firstly announced a truly ambitious reform and simplification of health and unemployment benefit systems within the existing social security tax framework (Contribution Sociale Généraliséé). An important part of his reform agenda is the evaluation of current reimbursement mechanisms as well as access to care – for instance glasses, dental implants or hearing aids will be completely reimbursed by 2022. In addition, Macron wants to introduce an in-depth assessment of necessary treatments to be excluded from de-reimbursement policies – a topic that will likely receive a lot of attention from the pharma industry. Finally hospitals, as all public services, will be required to evaluate the quality of their services each trimester based on indicators such as delay in treatment and waiting times.

To top this already ambitious agenda, Macron promises an investment of €5 bn. between 2018 and 2022 into primary care, hospitals and healthcare innovation. These investments aim for a much needed reform of the French hospital system and healthcare coverage in rural areas. Following a re-organisation of healthcare and hospital systems on regional level, hospitals will be required to cooperate with local health authorities and professionals to fight unnecessary surcharge. Macron also aims to double the number of local interdisciplinary healthcare centres to further enhance healthcare coverage in rural areas – a project already initiated by President Hollande.

However, beyond investments, a ground-breaking reform of primary care and pharmacist services is unlikely. Macron wants to simplify training processes for medical students and increase remuneration of local general practitioners. In a recent letter to the pharmacist organisation Union des syndicats de pharmaciens d’officine (USPO), Macron’s health referent Dr Olivier Veran stressed that challenges to pharmacists’ businesses like mail-order of prescription (Rx) medicine and the availability of over-the-counter (OTC) medicines in hypermarkets will be addressed in a consensual way, with all necessary stakeholders. Immediate attempts to liberalise the pharmacy market, as many pharmacists fear, are unlikely.

In the end, it remains questionable whether his ambitious investments and reforms will be popular and financeable. Many of his proposals simply prolong policies introduced by Francois Hollande, or remain quite vague: while his plans to completely reimburse glasses, dental implants or hearing aids are progressive, it is not clear which kind of devices will be reimbursed nor which funding sources he will use. According to research conducted by French magazine ‘Les Echos’, such measures could cost up to €4 bn. Conclusion: ambitious plans, mais patience s’il vous plait.

Innovation

There is no ambitious policy agenda without a big focus on innovation. Macron announced a €10 bn. fund to finance future industries, in order to further provide French laboratories with incentives to produce their solutions in France and accelerate access to innovative medicines. Investments in new technologies are intended to revolutionise patient pathways and access to healthcare. Macron counts for example on telemedicine services which he says will massively lower pressure on primary care services, especially in rural areas.

Investments in innovative medicines will be supported by simplified authorisation procedures, the promotion of generic medication, and savings produced by the introduction of per unit sales of medication – measures that have received a lot of attention (and in some cases criticism) by pharmacists and the pharma industry.

Whether these proposals will lead to very concrete and far-reaching actions will depend on the announced negotiations with involved stakeholders. The French Parliament could further block the ambitious investment plans. When it comes to eHealth, Macron’s proposals remain vague and do not touch upon issues related to data protection, or the free flow of data across borders.

So what does this mean for Europe?

It can be expected that Macron will mostly follow policies introduced by his predecessor, and not set any new incentives in EU healthcare policies. Apart from his pledge to lead the fight against endocrine disrupters, and his support for the French candidature for the EMA headquarters, there are no further references to EU initiatives in his programme.

With his ambitious investment plan and focus on prevention strategies instead of treatment, he however seems to understand the main challenges to healthcare systems in Europe in general. It is therefore not impossible that some of his measures, like the support of the Nutriscore food labelling system, ambitious tobacco policies, and the introduction of per unit sales of medication may find imitators in other Member States.

The upcoming legislative elections may however quickly set limits to his reform plans. His healthcare agenda will have to withstand difficult talks with healthcare providers, patient groups, and industry – notably after an intense and controversial Presidential campaign. Many therefore already speculate that the position of Health Minister might be reserved for Dr Olivier Veran – a neurologist from the University Hospital in Grenoble who is seen as an ambitious thought leader in healthcare prevention, and who became popular with his ban of skinny models in France. Strong allies in the government may help Macron in pushing through his agenda.

In his programme, Macron says: ‘Europe needs to change: Its mission is not to administer, but to protect the present and prepare our future.’ Whether this credo also applies for the reform of the French healthcare system remains to be seen.